Extrication as a Predictor of Outcome in Motor Vehicle Crashes

Background Motor vehicle accidents are one of the most common causes of severe injury and death worldwide. The process of assisted removal, performed by emergency medical services, is termed extrication. Extrication is only warranted in severe collisions, which leads one to assume it may be associated with worse outcomes. The goal of this study is to review existing literature regarding extrication as a marker of prognosis and investigate whether or not this trend is seen in our level 1 trauma registry. Methodology We conducted a retrospective cohort study on patients from our trauma registry between 1/1/2016 and 1/1/2021. During this time 3,318 patients met trauma activation criteria following a motor vehicle collision and were then categorized based on their extrication status. We queried the dataset for demographic information (gender, race, ethnicity, age) and markers of poor prognosis (admission rate, ICU admission rate, GCS, average ISS, average ventilator days) and compared rates of extrication within each of these groups. Using Microsoft Excel, we ran Student t-tests to calculate p-values for quantitative variables and chi-squared tests to calculate p-values for qualitative variables, to assess for statistical significance. Results Around 36.32% of extricated patients required admission to the medical floor, compared to 32.73% of non-extricated patients; 35.47% of extricated patients required admission to the ICU whereas 17.30% of non-extricated patients required ICU admission. There was a higher rate of death in the emergency department in extricated patients compared with non-extricated patients with 2.14% of extricated patients requiring transfer to the morgue, and 0.84% of non-extricated patients. The p-value for the T-Test comparing extrication among these various dispositions was < 0.005 indicating a statistically significant association between extrication and disposition. The rate of presentation with a GCS of less than 9 was higher in extricated patients; 12.44% of extricated patients presented with a GCS of less than 9 compared with 3.93% of non-extricated patients. This p-value was < 0.005 indicating a statistically significant association between extrication and GCS. Extricated patients had a higher injury severity score on average (13.21) compared to non-extricated patients (7.09), they had longer duration of mechanical ventilation (9.75 days) compared to non-extricated patients (6.21), longer average ICU stays (8.31 days) compared to non-extricated patients (4.99 days), and longer hospital admissions (11.01 days) compared to non-extricated patients (5.97 days). These variables were independently assessed via Student t-test and found to have p-values < 0.005 indicating statistically significant associations between extrication and average ISS, duration of mechanical ventilation, and length of stay in the ICU and hospital. Conclusions Vehicle extrication following motor vehicle collisions demonstrated a statistically significant association with markers of poor prognosis including rates of medical floor admission, ICU admission, death in the emergency department, likelihood of GCS < 9, higher injury severity score, longer duration requiring mechanical ventilation, and longer ICU and general hospital stays. Understanding that vehicle extrication is associated with poor prognosis will inform providers working at trauma centers that these patients are more likely to require critical care services.